On page 349, Vol. IV, of the Review, it was proposed to discuss Scarlet Fever, as fatal through local action of its morbid cause on the brain and throat. The class of cases affecting the brain has been considered. It remains, therefore, now only to dispose of that affecting more especially and dangerously the throat. This, for practical convenience, may be divided into four varieties, according as different tissues are the seat of this localization, or as different phenomena are developed in them, in the progress of the case, viz.: simple inflammation of the mucous membrane; inflammation and ulceration of that membrane; inflammation of the submucous tissue, and inflammation of the subcutaneous tissue.
These affections are as different in their curative relationships as they are in their location and visible appearances. They characterise an important class of cases of the fever we are considering, to which they impart no small degree of suffering and danger, and hence a careful study of their peculiarities, in order to discover, if possible, a more perfect treatment of them, can hardly be other than useful.
That affections so differing in location and phenomena should be best met by anyone supposed specific; that this should be blindly selected and given without regard to the individual characteristics of the case under treatment or to the general differences which mark the varieties as we have stated them, is both absurd and criminal. This must be as obvious to the most inexperienced as to the most wise; and as apparent to the slightest attention as to the most extended observation. And yet this whole class of cases, in all its variety, has oftener been treated in the past, it is safe to say, with the one drug, Belladonna, than with all others, so great is the power of practical habit. Especially is this true of the beginning of the treatment. This is explained by the force with which the idea of a specific for classes of diseases has grasped the minds of practitioners, and it well illustrates the tenacity with which we are all disposed to cling to an idea which promises to save us labor. This practice has been persisted in these many years, with ready confidence, in each successive new case, though it is certain it never yet cured or even benefited some of the forms of these throat affections. It also illustrates the power of that habitual deference to authority which has ever characterised the medical profession, and which in the old school compelled the continued drawing of blood for the cure of inflammations, for 3000 years, treating him as a heretic and an outlaw, who should dare to call in question the necessity of this resort, though it has recently been established, beyond question, that all this while bleeding was only injurious, in these cases, increasing the rate of mortality and protracting the period of convalescence. What bleeding was to the mind of the old school, in the treatment of inflammations, Belladonna has been, and is, in the new, in the treatment of scarlet fever. Both have been used without question and without thought, because of the words of authority. The difference is, however, that in the new, Belladonna once was a cure for this disease, as it was then met; while from recent enlightened observations there is reason to believe that bleeding never was the great remedy for the class of diseases in which it was most practiced and trusted, that past generations confidently believed it to be. There is no such evidence of change in the nature of inflammations, in modern time, calling for change of remedies, as we have already seen in the early part of our discussion, of scarlet fever. In following the teachings and practice of antecedents, the old school was consistent with itself. It was never, in all its changes of opinion, other than a school of authorities. In successive generations the multitude followed the then dominant leader, never looking beyond his dictum. Hahnemann's appeal was from this to living facts - from theoretic dogmatism to the results of positive experience - to an experience the result of enlightened, careful and protracted observation. By this he claimed to have discovered and established the great law of cure. The homoeopathic school acknowledged the justice of this claim, and the importance of the methods by which he sustained it. And yet, by force of the habit which in all the past has been the great bar to therapeutic progress, many of those who acknowledge the truth and value of Hahnemann's discovery, are prone to forget the first cardinal principle which resulted, as the foundation of all practical duty - the necessity of strict individualization in every case of disease to be treated. — Habit has suggested and still suggests, did not the master say Bellad. was the great specific for scarlatina? while Reason forgets to reply, that if the appeal be to the master, the whole current of his teaching declares that this can only continue true while the individualities of the disease and the drug continue to be like each other. If this similarity, by virtue of which alone the drug ever was a cure of the disease, ceases to be, then the drug becomes only a neutral in the treatment, whatever may have been its importance in other circumstances. It has no power imparted by the dictum of the master, and we are to have no confidence in it, except as we see the required similarity. It may be convenient to entertain faith in general specifics. It makes duty easy, but it is not safe.
The duty of individualization is nowhere more imperative than in the treatment of scarlatina with important affections of the throat. This extends as much, if not even more, to the general as to the local symptoms, In relation to the first, the general, there can be no better method by which to carry out this duty than that given in the Organon. To take all the phenomena of a case into consideration, and give to each the attention its importance demands. Till this is done it can never be known what are the elements which individualize the case. There is nothing in the mind of the prescriber, pertaining to the disease for which he is to find, in the known pathogenesis of drugs, a simillimum. He is ignorant of the first elements of the problem he is about to attempt to solve. The more earnest care should be given to these general symptoms, because in them are often found the individualities of the case, and these are the elements which dominate all intelligent prescribing. In comparison with these, the redness of the skin and throat, which are so apparent and intrusive on the attention of the physician, are often of little importance. These general symptoms cannot be discussed in a general consideration of the subject, so great is the variety of form and combination in which they present themselves, even in successive cases of the same epidemic. In different epidemics, of course, the variety, (and consequently the variety of any attempt at a succinct analysis of them,) is increasingly apparent.
In regard to local symptoms, these are less numerous, and easier brought within the grasp of the prescriber. First, he ascertains what of local changes from healthy appearances he can see, and then what of change in the sensations, from the natural state, does the patient feel. In finding the curative, these last are far more important than the first. Unfortunately, in too many cases, these are excluded by the age or condition of the patient. Still, wherever they can be availed of, they greatly facilitate the selection of the true remedy. In applying these remarks to the treatment of the first form of throat affection, in the division we have suggested, that of inflammation of the mucous membrane, the appearances as to color, dryness, and the degree of swelling, are to be noted, and then, if possible, the attending abnormal sensations, and conditions in which these are either excited or aggravated. If the inflammation be limited to the membrane, the swelling will be but slight, and the impediment to swallowing less than when the deeper tissues are involved. If, in these cases, there be also great dryness in the throat, with sense of constrictive suffocation, disposition to constant swallowing, and feeling as if of impending suffocation if the patient does not swallow, heat and smarting as if the throat were raw (Nux vom.), sensation of swelling in the throat as if there were a lump (Lachesis), especial difficulty in swallowing liquids, there need be no hesitation in giving Belladonna. It will probably afford prompt relief. There need be no nervous excitement here to give much of the drug, or to give it very often, for fear a worse state will ensue if this is neglected. These symptoms are so characteristic of the drug that it will not fail if it has a fair chance, i. e., if it be not given in too great quantity or too often, and if it be not interfered with by the presence of other drugs, as sometimes will happen from the nervousness and apprehension excited by the bad reputation of the disease, because of its known fatal tendency to assume sudden and unfavorable appearances and conditions. The thought is, perhaps, that this may be forestalled by the interposition of one or more drugs the action of which it is hoped will anticipate and prevent this lapse, if only the patient receives enough of them. This is a great mistake. Like as in many other instances, nervous apprehension here, by this resort, insures the realization of its fears, by the very means it adopts to prevent it. It arrests, embarrasses, or destroys the action of the true remedy, if this indeed has been found; or it adds to the confusion produced by the action of the wrong, by increasing impressions, which are not curatives, from other wrongly selected drugs, till to the dismay of the prescriber he may find, when he least suspects it; the same of these confusions to constitute the very evil he dreaded, and to avoid which he has resorted to the very means which has produced it. To avoid all this let the prescriber be sure of his remedy first, before giving it, and then trust it for the desired result. If the remedy be the right one, it needs no supplementary aid; if not, then the patient needs something else, but not this. There can be not the slightest doubt in the mind of any enlightened and reflecting practitioner, that very many of these sudden and unfavorable changes in the progress of cases not yet disclosing malignant character, are the result of wrong and excessive medication.
It can hardly be necessary to say that the mere condition of the throat with the sensations, etc., attending, is never to be isolated from the other elements of the case, and made the basis of a prescription. The present intention is only to present it as one of the localizations of the disease which is a source of danger to life, and to endeavor to simplify its successful treatment by a clearer view of its relation to remedies by the law of cure. The variety we have just considered is generally the least dangerous of them all, and usually easy of control. It is met in the milder forms of the fever, and often disappears, with the other elements of the case, giving little trouble beyond the increased difficulty of swallowing and the comparatively slight addition to the sufferings of the patient it may have caused. If the inflammation does not proceed to attack other tissues, it rarely requires for its removal more than a dose or two of Belladonna. But it may require Nux vom. if there be rawness, burning and smarting with loss of dryness, and the absence of the constrictive and suffocating sensations; if the dryness be rather of the front part of the mouth, than of the back and throat, and if there be at the same time shootings in the uvula and maxillary glands. Or Baryta carb. may be preferable if there be great difficulty in opening the mouth, of speaking and swallowing.
|The American Homoeopathic Review Vol. 06 No. 03, 1865, pages 104-109
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